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Abstract
BACKGROUND
The Canadian Neonatal Follow-Up Network (CNFUN) was developed in 2008 to facilitate collaboration in research by providing a national database and implemented standardized neurodevelopmental assessments at 18 and 36 months corrected ages for babies born <29-week gestational age. Previous Canadian surveys showed a large variability in neonatal follow-up practices. This is the first Canadian national survey since the establishment of CNFUN.
OBJECTIVES
To describe the current status of neonatal follow-up services in Canada and to evaluate the impact of CNFUN by comparing the results of the current survey to a 2006 survey. Proportions are compared using chi square, p value < 0.006 adjusted for multiple comparisons.
DESIGN/METHODS
All 26 Level-III University Affiliated Neonatal Follow-up programs in Canada belonged to CNFUN and were invited to participate in this comprehensive online survey. Questions were based on previous survey results, current literature and discussion amongst the investigators.
RESULTS
23/26 (88%) of invited programs completed the survey. Scope of service: All programs provided neurodevelopmental screening and referral for intervention. Data collection, training and education were provided by most programs (>80%). Therapeutic interventions were offered by a smaller number of programs (>50%). Type of Assessments: The use of Bayley Scales of Infant and Toddler Development increased significantly since 2006. For speech and language, adaptive behavior, and psychological standardized assessments tools a large variation remains. Follow-Up Schedule: Most programs offer between 5 to 7 follow-up visits. There remains a great variability in the timing of visits. Eligibility Criteria: The use of gestational age eligibility criteria, the inclusion of up to 29 weeks, and the expansion to include additional neurologic, cardio-respiratory, and fetal diagnosis has increased since 2006.
CONCLUSION
CNFUN was associated with a clinically important, statistically non-significant standardization. Non-preterm eligibility criteria have increased. Marked variability in Neonatal follow-up practices persist. Standardized follow-up has potential benefits of including facilitating multi-centered research, site benchmarking, and continuity of care for families who move.
| 2006 | 2017 | P-Value | |
| Schedule | |||
| 18 months Follow-up | 16/19 (84%) | 21/23 (91%) | 0.48 |
| 3 years Follow-up | 14/19 (73%) | 19/23 (83%) | 0.48 |
| Standardized Assessments | |||
| Bayley – III Cognitive Scale | 4/19 (21%) | 19/23 (83%) | 0.0001 |
| Bayley – III Motor Scale | 4/19 (21%) | 17/23 (74%) | 0.001 |
| Eligibility Criteria | |||
| <29 wks GA | 5/19 (26%) | 15/23 (65%) | 0.01 |
| Neonatal Stroke | 1/19 (5%) | 20/23 (87%) | <.00001 |
| Congenital Diaphragmatic Hernia | 4/19 (21%) | 15/23 (65%) | 0.004 |
| Fetal diagnosis & Therapies | 1/19 (5%) | 12/23 (52%) | 0.001 |